HCA 620 Preliminary Literature Review

HCA 620 Preliminary Literature Review

HCA 620 Preliminary Literature Review

Evidence-based research refers to use of sound research to make decisions pertaining patient care (Mackey & Bassendowski, 2017). To achieve this, one had to assess patient and the need for change, come up with a clinical questions according to patients’ problem, conduct a thorough search to get best evidence, appraise the evidence for usefulness and validity, integrate the evidence obtained with patient preferences and clinical expertise and apply and evaluate the outcomes achieved. The purpose of this paper is describe a patient problem and propose a solution, review literature and outline the action item checklist.

Problem Description

A major safety concern in hospitals is patient falls. The concern arises because fall-related injuries are linked to prolonged hospital stays, surgery and at times death (Harianto & Anpalahan, 2017). Additionally, patients who do not sustain physical injuries develop a fear of falling, reducing their mobility and increasing their risk of falling. Patients, carers, and staff also present with psychological distress, complaint, litigation, guilt and dissatisfaction which affect care provision negatively. It is estimated that three to five falls occur per 1000 bed days and 700, 000 to one million patients fall annually (Stephenson et al., 2015). Hospital falls are catastrophic because a third of them result in serious injuries like head trauma and fractures. Research also outlines that falls with injury prolong the hospital stay with 6.3 days with an increased management cost of $14,000 (Stephenson et al., 2015).

A risk factor that increases the probability of falls is age with patients above 65 years having a higher risk due to confusion, bladder incontinence, and walking limitation. Fall risk is also increased by gait instability, agitation, neuro- cardiovascular instability and adverse drug reactions (King et al., 2016). Absence of fall prevention policies coupled with absence of healthcare provider also increase the risk of patient falls. The postoperative patients also tend to have higher fall rates since patient health status and frequency of medication taken are linked to falling risks. Lastly fall risks increase with prolonged stay in the hospital, manual transfer of patients and fall history.

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There is a need to come up with fall prevention measures with nurses and other health care providers at the forefront. The practitioners have to appraise research and come up with patients-friendly and safety policies that address patient falls. Research indicates that measures like use of high-risk wristbands, providing mobility aids, vitamin D prescription, medication review, and bed signage are some of the measures that have been adopted in hospitals to prevent falls. (Taylor & Hignett, 2016). Additionally creation of diverse prevention teams, raising awareness on patient falls and using patient falls as training opportunities have also be applied as fall prevention strategies. A promising approach to patient falls is nurse rounding although response to call lights and bed alarms also mitigates patient falls since most of the falls occur when trying to perform routine actions or going to the bathroom without support.

Proposed Solution

Most of the provided interventions lack conclusive evidence on their ability to prevent or reduce fall incidents. A

HCA 620 Preliminary Literature Review
HCA 620 Preliminary Literature Review

promising intervention is nursing round which is the proposed intervention that will be handled in this paper. Nursing round refers to an evidence-based intervention that is systematic, proactive and nurse-driven which helps in anticipating and addressing patient needs (Daniels, 2016). Research indicates that it reduces patient falls and use of call lights which increases nurse satisfaction and efficiency. Nursing rounds also promote patient safety, enhance staff ability to offer efficient patient care and encourage team communication. For this research, nursing rounding will be compared with use of call lights in fall prevention and reduction among patients in the medical-surgical units. The PICO question guiding the research is:

For adult inpatients in medical-surgical units, does the use of nursing rounds reduce the future risk of falls when compared with call lights?

Literature Review

Literature that supports the proposed research intervention for the evidence-based practice was reviewed and ten articles were included in the appraisal. It is worth noting that there is an acute shortage of evidence on the use of nursing rounds to reduce incidences of falls among hospitalized patients. This can be seen from the fact that a majority of the articles are systematic reviews, with one of them dated back to the year 2006. The appraisal of the research articles showed that there is moderate evidence on the efficacy of using nursing rounds to prevent or reduce prevalence of patient falls. The frequency of nursing rounds that were examined in these articles is hourly nursing rounds. While one article reported nursing rounds to be associated with outcomes that are not statistically significant, the findings have some clinical significance due to the duration of the study and the variables that were under investigation.

Mitchell, Lavenberg, Trotta, and Umscheid (2014) conducted a systematic review of literature that aimed at investigating the effect of nursing rounds on nursing responsiveness. The authors searched databases that included EMBASE, CINAHL, and Medline for studies on the topic. The outcomes of the review demonstrated that hourly nursing rounds have a significant effect on the satisfaction of patients with care, patient falls, and call light use. While this conclusion has an impact on the proposed intervention, this research had low reliability due to the methods that were used. Firstly, the articles that were used in the review had considerable variability in their study protocols. They also had methodological bias, which lowered their significance. However, being among the few studies on the topic, the current study will rely on its conclusions on the efficacy of nursing rounds in preventing patient falls.

Goldsack, Bergey, Mascioli, and Cunningham (2015) conducted a pilot study that aimed at examining the effect of hourly nursing rounds on patient falls. The study was conducted over a 30-day period in two units to determine the impact of the intervention on patient falls and utilized the support from nurse leaders, who acted as the champions for the intervention. Study outcomes from this research demonstrated significant efficacies in the use of nursing rounds to prevent or reduce patient falls. According to the outcomes, a decline in the patient fall rate in unit one by 3.9 falls per 1000 patient days was reported. There was also a decline in patient fall rate in the pilot period by 1.3 falls per 1000 patient days, which was lower than the predicted baseline fall rate. The fall rate in the second unit was 2.6 falls in every 1000 patient days.

However, the fall rate during the pilot period was not significant as evidenced by a fall rate of 2.5 falls per 1000 patient days from 2.6 falls per 1000 patient days. Therefore, the authors concluded that the use of nursing rounds is only effective if there is adequate interdisciplinary engagement as seen from the study findings from unit one. The study findings reported by Goldsack et al. (2015) can be relied on wholly for this intervention. This can be seen in the reliability and validity of the methods that were used. The study period also allowed for the identification of any effect of intervening factors on the study variables.

Daniels (2016) conducted a study that aimed at examining the effect of purposeful as well as timely nursing rounds on patient safety and satisfaction. The intervention was implemented in the clinical setting where nursing rounds were done hourly to promote the outcome measures of the research. The study outcomes revealed that there was doubling of the intervals of nursing rounds during sleeping and awake hours. There was a substantial increase in compliance with the intervention up to 64% from zero. The outcomes included substantial increase in patient toileting by 41%, responsiveness of the staff by 15% and reduction inpatient falls by 50%. Therefore, the researchers recommended the use of purposeful as well as timely nursing rounds to promote patient safety in relation to aspects such as prevention of falls and improvement in staff responsiveness. The outcomes reported by Daniels (2016) in his study can be relied upon in the proposed intervention. This is attributed to the reliability and validity of the methods used in investigating the research topic.

The study conducted by Tucker, Bieber, Attlesey-Pries, Olson, and Dierkhising (2012) aimed at examining the feasibility of using structured nursing rounds interventions in preventing patient falls in practice. The researches utilized a repeated measures design where risk assessment and fall rates data were obtained over a 12-week period and one year after the intervention was implemented. Results showed a significant decline in falls per 1000 hospital days with a considerable fall in the scores of mean fall risk assessment. However, these rates returned to baseline after one-year period. Therefore, the authors concluded that while the intervention might prove effective in reducing incidence of falls among patients, models that sustain the use of the intervention should be embraced. This study is associated with significant strengths. It has high research validity since the sample, methods of data collection and analysis, and observational procedures are explicitly explained. Consequently, it forms the basis of the proposed intervention for this evidence-based practice proposal.

Additionally, Jackson (2016) executed a quasi-experimental study that aimed at reducing patient falls within a nursing home using a collaborative multi-strategy fall risk management program. During the study, direct care providers conducted every 2-hour rounding on patients and staff participated in training and education on fall prevention strategies. The rounding concentrated on 4Ps (potty, possession, positioning, and pain) and documentation. The number of patients in the nursing home was 150 with patient’s median age being 75. A team of 10 participants was selected to handle the program and they filled questionnaires before and after the program implementation. Prior to the program, the mean fall rate per month was 24.5 out of 120 patients but after implementation the fall rates reduced to 13.5 after 2 months and 9.5 after four months. The study indicates that fall rates reduced by 53% indicating that nurse rounding would help in mitigating fall rates within the medical-surgical unit. However, the study was limited because of a small sample and time-consuming documentation process for the 2-hour rounding for each patient.

Leon and Adams (2016) also executed a retrospective review that assessed the fall rates in an inpatient rehabilitation unit. They implemented multiple fall prevention interventions namely safety huddles. Signage and hourly rounding. Safety huddles were implemented in early 2011 to enhance shift-to-shift communication. Afterwards, signage was placed in the bathroom to prevent toilet-related falls and lastly hourly rounding was implemented after thorough education of the healthcare providers. The researcher indicates that each fall prevention lowered the fall rates upon initial implementation however they did not sustain overall fall rate reduction. Of worth noting was that hourly rounding was an effective approach because the total fall rate in the unit reduced to less than one (0.65) per 1000 patient days. The researchers support that indeed hourly rounding is an approach that can be used to reduce fall rates within a hospital setting.

To support the use of nurse rounding, Morgan et al. (2016) executed a study that used a nursing staff-led intentional rounding intervention to curb inpatient falls. They used a specific implementation strategy that covered engagement and communication activities, training, support and coaching, and Plan-Do-Check-Act cycles. The study compared the fall rates within the inpatient and the ward and across the rest of the Trust. The results indicated patient falls reduced by 50% in the ward while it increased by 3.48% across the rest of the Trust. The article supports the need to integrate teamwork training, staff-led systems redesign, and fall implementation strategy to help in generating changes within the hospital setting.

Although not directly looking at fall rates, Francis et al. (2016) executed a qualitative evaluation of a single ward pilot. They used a mixed-method design and date was generated using non-participant observations, focus groups and interviews with nursing staff, and staff and patient satisfaction surveys. The objective of the study was to introduce “purposeful rounding” to enhance health care outcomes at St John of God acute care hospital. The authors found out that “purposeful rounding” made patient feel safer and reduced fall rates.

The research by Meade, Bursell, and Ketelsen (2006) investigated the effect of nursing rounds on patients’ satisfaction, safety, and call light use. The outcomes revealed that nursing rounds performed on specific intervals were associated with significant reduction in rates of patient falls and use of call lights and enhanced patient satisfaction rates. This study is associated with high reliability and validity. The intervention was implemented and its outcomes followed up for some time. The follow up allowed the researchers to explore possible intervening factors that might affect the outcomes of the study. The methods of variable analysis are also adequate as they pointed out the existing relationship with the outcomes of the research. Research by Walsh et al. (2018) showed that the use of multifaceted fall prevention intervention improved the trends of fall rates among hospitalized patients. The multifaceted program, which included the use of nursing rounds, showed that there was significant decline in patients’ falls and injuries due to the use of hourly rounds to mitigate risks of falls. Therefore, based on these sources of evidence, it proves apparent that the use of nursing rounds has enhanced efficacy when compared to call lights in prevention and reduction of falls among hospitalized patients.

Action Items Checklist

TASK DATES DESCRIPTION
Project Description Jan 04 2019- Jan 10 2019 Research on the issue of patoient falls and right a comprehensive description of the problem.
Proposed Intervention Jan 12 2019-Jan 15 2019 Research on the effectiveness of call lights and nursing rounds in preventing patient falls.
Literarure Review Jan 17-Jan 23 2019 Conduct literature reveiew form evidence-based studies to support the interventions. A total of 25 artciles will be analyzed for this section.
Solution Description Jan 24- 27 2019 Using evidence from literature, a solution description will be provided as regards the issue of patient falls. Based on the literature, the better intervention will be elected.
Change Model Discussion Jan 28-Feb 2 2019 An analysis of change model for the project. Various models will be considered with the best being chosen for the capstone project.
Project Implementation Plan Discussion Feb 3-10 2019 The section will entail discussing the plans on how the project will be implemented. The discussion will involve the hospital section wherein the implementation of the project will occur.
Evaluation Plan Discussion Feb 11-17 2019 Evaluating the effectiveness of the capstone solution will be done at this point. All the aspects of the issue that should be improved particualy reduction of patient falls will occur at this point.

 

References

Daniels, J. F. (2016). Purposeful and timely nursing rounds: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports14(1), 248-267.

Francis, K. L., Steele, C., Noonan, M., Ryan, M., Walter, D., & Kurtsev, A. (2016). Piloting, evaluating and modifying ‘purposeful rounding’an evidenced based approach to nursing care: A private Catholic Health services approach to embedding evidence into practice. International Journal of Evidence-Based Healthcare, 14(4), 187-188.

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: What factors boost success?. Nursing201945(2), 25-30.

Harianto, H., & Anpalahan, M. (2017). In-hospital Falls in Older Patients: The Risk Factors and The Role of Hyponatraemia. Current aging science, 10(2), 143-14

Jackson, K. M. (2016). Improving nursing home falls management program by enhancing standard of care with collaborative care multi-interventional protocol focused on fall prevention. Journal of nursing education and practice, 6(6), 84-96.

King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2016). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist58(2), 331-340.

Leone, R. M., & Adams, R. J. (2016). Safety standards: implementing fall prevention interventions and sustaining lower fall rates by promoting the culture of safety on an inpatient rehabilitation unit. Rehabilitation Nursing, 41(1), 26-32.

Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55.

Meade, C. M., Bursell, A. L., & Ketelsen, L. (2006). Effects of nursing rounds: On patients’ call light use, satisfaction, and safety. The American Journal of Nursing106(9), 58-70.

Mitchell, M. D., Lavenberg, J. G., Trotta, R., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: A systematic review. The Journal of Nursing Administration44(9), 462.

Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2017). Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls. Journal of clinical nursing, 26(1-2), 115-124.

Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A. (2015). Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project. International Journal for Quality in Health Care, 28(1), 92-98.

Taylor, E., & Hignett, S. (2016). The SCOPE of hospital falls: A systematic mixed studies review. HERD: Health Environments Research & Design Journal, 9(4), 86-109.

Tucker, S. J., Bieber, P. L., Attlesey‐Pries, J. M., Olson, M. E., & Dierkhising, R. A. (2012). Outcomes and challenges in implementing hourly rounds to reduce falls in orthopedic units. Worldviews on Evidence‐Based Nursing9(1), 18-29.

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal trends in fall rates with the implementation of a multifaceted fall prevention program: Persistence pays off. The Joint Commission Journal on Quality and Patient Safety44(2), 75-83.